Independence Blue Cross ACO
Program Location:
Harrisburg, PA
Payer Type:
Commercial
Payers:
Independence Blue Cross
Reported Outcomes
Description:
Independence Blue Cross is a nationally recognized health insurer serving nearly 8.8 million people in 24 states and the District of Columbia, including 2.5 million in southeastern Pennsylvania. Independence’s Accountable Care Organization (ACO) payment model has been embraced by more than 90 percent of the health care delivery systems in the region. The Independence accountable care payment model requires health care providers, often a hospital and its affiliated primary care physicians and specialists, to establish an ACO-like entity that shares responsibility with the insurer for improving clinical performance and cost efficiency for the care delivered to patients.
Payment Model:
Under the Independence accountable care payment model, half of the potential earnings for the hospital and physicians are based on their ability to improve their performance related to hospital acquired infections, patient experience, readmissions, and surgical care, and the treatment of heart attacks, heart failure, and pneumonia. The other half of the potential incentive payment is based on their ability to manage costs through greater collaboration and coordination of inpatient, outpatient, ancillary care, home health, prescriptions, and other health services.
Fewer ED / Hospital Visits:
- Nearly 90 percent of the participants lowered hospital readmission rates with an average reduction of 16 percent in the first year
Improved Health:
- 100 percent of the health systems improved at least one hospital-acquired infection measure or received a top distinction from the Pennsylvania Department of Health for infection control in the first year of program implementation
Improved Patient/Clinician Satisfaction:
- Nearly all participants scored better in measures that assess patients’ experience during their hospital stay such as their understanding of information about recovery at home in the first year of program implementation.
Cost Savings:
- Half of the hospitals participating successfully reduced their medical costs in the first year of the program, determined by customized targets based on historical costs
Data Source(s):
